MEDICARE: R. GREG KUYKENDALL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237700000X	Hearing Instrument Specialist	451	OK

General Provider Information

NPI Number	:	1629189931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	R. GREG KUYKENDALL

Provider Business Mailing Address
First Line	:	3201 N VAN BUREN ST STE 200
Second Line	:
City	:	ENID
State	:	OK
Zip	:	73703-1800
Country	:	US
Telephone Number	:	580-234-6168
Fax Number	:	580-233-4130

Provider Business Practice Location Address
First Line	:	3201 N VAN BUREN ST STE 200
Second Line	:
City	:	ENID
State	:	OK
Zip	:	73703-1800
Country	:	US
Telephone Number	:	580-234-6168
Fax Number	:	580-233-4130

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	03/12/2008

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